Virginia General Assembly begins round two of Medicaid debate

Medicaid, state budget to dominate special session, as they did the regular

March 23, 2014|By Travis Fain, tfain@dailypress.com

RICHMOND — The Virginia General Assembly gets back to town Monday for a second round of the budget and Medicaid debate that ground the last session into deadlock.

This special session will gavel in around noon, and rank-and-file members will likely be around for just a few days to vote on the perfunctory first steps of formally renewing negotiations.

The negotiations proper will be handled by a smaller group of negotiators representing three sides: House Republicans, a coalition of state Senators and Gov. Terry McAuliffe.

The governor plans to meet with House and Senate negotiators — conferees, in the legislative parlance — over breakfast Monday morning. Their negotiations could easily last for weeks.

McAuliffe has hinted at some surprises in the budget proposal he plans to release Monday morning. It will still be based on former Gov. Bob McDonnell's initial $96 billion, two-year proposal from January, McAuliffe has said, but the new governor is rewriting some portions more to his own liking.

Just what that means, he won't say until Monday.

House leaders want to move past that. They filed their own version of the budget, saying it was based in part on agreements that House and Senate negotiators struck near the end of the last session, which ended March 8.

Among other things, that budget includes a 1 percent pay increase for teachers, though not until 2015. There was back and forth between the House and Senate over the weekend, though, over whether that budget, or the one McAuliffe will propose, should be used as a starting point for negotiations.

Procedural tifts aside, Medicaid expansion remains the sticking point. It was the same story during the regular legislative session, which ended with an unfinished budget and the Medicaid debate unresolved.

To recap: McAuliffe campaigned last year on Medicaid expansion, which would tap some $2 billion a year in federal money available through the Affordable Care Act, often referred to as Obamacare, to provide health insurance to hundreds of thousands of poor and uninsured Virginians.

The state Senate, which is divided down the middle between Republicans and Democrats, got on board with a plan that would take most of that federal money and use it to buy private insurance plans for the people who would otherwise benefit from outright expansion. They call this plan Marketplace Virginia, and McAuliffe supports it.

House Republicans, who hold 68 of their chamber's 100 seats, are standing in the way. The federal government has promised to pay 100 percent of expansion costs for the first few years, but that share drops to 90 percent soon after. Republicans, in Virginia and across the nation, say they worry that the federal government will eventually drop that rate, and probably sooner rather than later.

Some say it could go as low as the 50-50 state-federal split that funds Virginia's existing Medicaid program, and that would blow up the state budget. Plus, they argue, Medicaid as-is grows too fast, is too unwieldy and needs a host of reforms that have only been put in place over the last year or so.

Give those reforms time to work, they say. Also, they want McAuliffe and the Senate to take the Marketplace Virginia plan out of the state budget, where it now sits as a negotiating tactic.

Pass a clean budget, Republicans say. Provide some certainty to the local school systems and governments that need to know how much state funding to expect come July 1, the start of a new fiscal year.

As of Friday, 36 local governments or elected leaders representing more than 3.3 million people had reached out to urge the governor to decouple expansion from the budget debate, according to Speaker of the House William J. Howell's office. Senate Republican leaders — who aren't necessarily jazzed about Marketplace Virginia, despite its support among Senate Democrats and a few Senate Republicans — put out the same call Friday.

Such a shutdown is a distant option, but it's a possibility if the House, Senate and governor can't agree to a new budget by July 1.

"If the Senate budget proposal did not include Marketplace Virginia, the great chasm that currently exists between the House and Senate would be gone," Norment said in the release. "If the governor would act to keep his promise today, we would be able to have an agreement on legislators' desks before the end of the coming week."

Do that, plus the reforms and a new two-year audit of the existing Medicaid system, then we'll talk about expansion, Republican House leaders have said.